Effects of Practice Combined with Somatosensory or Motor Stimulation on Hand Function in Persons with Spinal Cord Injury

Hoffman, Larisa R.; Field-Fote, Edelle C.

doi:10.1310/sci1904-288

Cited by 30 publications

(33 citation statements)

References 27 publications

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“…Our case-report describes an intervention similar the ones used in studies by Beekhuizen,et al [8,9] and Hoffman, et al [10,11]. However, our use of stereognosis as a sensory stimulation technique prior to motor TENS is what makes this a novel intervention.…”

Section: Discussionmentioning

confidence: 74%

“…The speed at which she achieved such improvement was remarkable, considering that her SCI was 7-years prior. Although studies have shown that improved function is possible in chronic SCI, [9][10][11] it is unlikely that we facilitated new neural connections and structural recovery after 7 years. More likely, this case illustrates an example of reversing maladaptive neuroplasticity.…”

Section: Discussionmentioning

confidence: 95%

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Use of Stereognosis combined with TENS to Promote Late Motor Recovery in an Individual with Incomplete Spinal Cord Injury: A Case Report

Muller¹,

Hastings²

2018

Phys Med Rehabil Res

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IntroductionIncomplete cervical spinal cord injury (SCI) is now the most common category of new traumatic SCI in the United States and13% of individuals with this type of SCI are sensory incomplete [1]. If interventions capitalizing on the sensory preservation can be used to facilitate motor recovery the population of SCI individuals will benefit. Hoffman and Field-Fote 2 have shown evidence of cortical reorganization after cervical SCI which likely reflects the decreased functional use of the upper extremity and the lessened sensory information. With electrical stimulation, Field -Fote has shown a reversal of this reorganization and proposed that electrical stimulation at sensory and motor levels could facilitate neuro recovery after SCI [2].Stroke literature discusses the concept of learned nonuse. This was originally posited by Carr and Shepherd [3] and then Wolf [4] formalized an intervention to target learned nonuse with constraint induced movement therapy (CIMT). To our knowledge the SCI literature does not have any published studies on learned nonuse, though some authors have suggested the phenomenon [5].Early observation of the behaviors of our case subject suggested a learned non-use phenomenon. She had a strong functional left (L) arm and though originally R handed she displayed agility and skill with her L hand. Her R arm was held in a protective posture. We describe an intervention using progressive sensory challenge training and motor electrical stimulation to reverse learned nonuse and facilitate recovery of functional motor strength in her paretic arm. Using the specific neurosensory retraining activities suggested by Montgomery and Connelly [6] as a guide we developed progressive stereognosis activities which were performed each session. These activities were followed by motor level electrical stimulation to the wrist extensors and finger extrinsic. Case descriptionThe case participant was a 19-year-old, Caucasian female who sustained a C5-C6 motor incomplete spinal cord injury following a fall in 2008 at the age of 12. The injury was incomplete, and she presented to our physical therapy clinic seven years later. After completing her course of physical therapy our participant consented to the preparation of a manuscript and poster presentation of her case, and the case review was approved by the Internal Review Board. AbstractBackground and purpose: Studies have shown that sensory stimulation in combination with massed practice can facilitate motor recovery following incomplete spinal cord injury (SCI). This case describes a combination of sensory and motor stimulation with stereognosis activities and TENS to promote motor recovery in one participant with incomplete SCI.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 95%

Use of Stereognosis combined with TENS to Promote Late Motor Recovery in an Individual with Incomplete Spinal Cord Injury: A Case Report

Muller¹,

Hastings²

2018

Phys Med Rehabil Res

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“…Participants were stratified into one of two functional levels based on total time to complete the seven timed test items (using the hand perceived by the participant to be more functional). Stratification levels were derived from data from our previous studies and were defined as follows: Stratum 1 (lower functioning) = total time of >200 s; Stratum 2 (higher functioning) = total time of <200 s (15). Each of the strata had an associated container holding a sequence of envelopes organized in the order of the randomization.…”

Section: Methodsmentioning

confidence: 99%

“…Functional task practice training of bimanual tasks was performed according to previously published protocols (15–17). The FPT activities were intended to incorporate movements and motor strategies that comprised common everyday activities.…”

Section: Methodsmentioning

confidence: 99%

Priming for Improved Hand Strength in Persons with Chronic Tetraplegia: A Comparison of Priming-Augmented Functional Task Practice, Priming Alone, and Conventional Exercise Training

et al. 2017

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Many everyday tasks cannot be accomplished without adequate grip strength, and corticomotor drive to the spinal motoneurons is a key determinant of grip strength. In persons with tetraplegia, damage to spinal pathways limits transmission of signals from motor cortex to spinal motoneurons. Corticomotor priming, which increases descending drive, should increase corticospinal transmission through the remaining spinal pathways resulting in increased grip strength. Since the motor and somatosensory cortices share reciprocal connections, corticomotor priming may also have potential to influence somatosensory function. The purpose of this study was to assess changes in grip (precision, power) force and tactile sensation associated with two different corticomotor priming approaches and a conventional training approach and to determine whether baseline values can predict responsiveness to training. Participants with chronic (≥1 year) tetraplegia (n = 49) were randomized to one of two corticomotor priming approaches: functional task practice plus peripheral nerve somatosensory stimulation (FTP + PNSS) or PNSS alone, or to conventional exercise training (CET). To assess whether baseline corticospinal excitability (CSE) is predictive of responsiveness to training, in a subset of participants, we assessed pre-intervention CSE of the thenar muscles. Participants were trained 2 h daily, 5 days/week for 4 weeks. Thirty-seven participants completed the study. Following intervention, significant improvements in precision grip force were observed in both the stronger and weaker hand in the FTP + PNSS group (effect size: 0.51, p = 0.04 and 0.54, p = 0.03, respectively), and significant improvements in weak hand precision grip force were associated with both PNSS and CET (effect size: 0.54, p = 0.03 and 0.75, p = 0.02, respectively). No significant changes were observed in power grip force or somatosensory scores in any group. Across all groups, responsiveness to training as measured by change in weak hand power grip force was correlated with baseline force. Change in precision grip strength was correlated with measures of baseline CSE. These findings indicate that corticomotor priming with FTP + PNSS had the greatest influence on precision grip strength in both the stronger and weaker hand; however, both PNSS and CET were associated with improved precision grip strength in the weaker hand. Responsiveness to training may be associated with baseline CSE.

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“…Many clinical studies suggest that both central and peripheral electrical stimulation improve long-term motor (90) and sensory recovery (204), including standing (48), walking (96,105,130,204), and hand function (106,129).…”

Section: Introductionmentioning

confidence: 99%

Electrical Stimulation and Motor Recovery

Young

2015

Cell Transplant

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In recent years, several investigators have successfully regenerated axons in animal spinal cords without locomotor recovery. One explanation is that the animals were not trained to use the regenerated connections. Intensive locomotor training improves walking recovery after spinal cord injury (SCI) in people, and >90% of people with incomplete SCI recover walking with training. Although the optimal timing, duration, intensity, and type of locomotor training are still controversial, many investigators have reported beneficial effects of training on locomotor function. The mechanisms by which training improves recovery are not clear, but an attractive theory is available. In 1949, Donald Hebb proposed a famous rule that has been paraphrased as "neurons that fire together, wire together." This rule provided a theoretical basis for a widely accepted theory that homosynaptic and heterosynaptic activity facilitate synaptic formation and consolidation. In addition, the lumbar spinal cord has a locomotor center, called the central pattern generator (CPG), which can be activated nonspecifically with electrical stimulation or neurotransmitters to produce walking. The CPG is an obvious target to reconnect after SCI. Stimulating motor cortex, spinal cord, or peripheral nerves can modulate lumbar spinal cord excitability. Motor cortex stimulation causes long-term changes in spinal reflexes and synapses, increases sprouting of the corticospinal tract, and restores skilled forelimb function in rats. Long used to treat chronic pain, motor cortex stimuli modify lumbar spinal network excitability and improve lower extremity motor scores in humans. Similarly, epidural spinal cord stimulation has long been used to treat pain and spasticity. Subthreshold epidural stimulation reduces the threshold for locomotor activity. In 2011, Harkema et al. reported lumbosacral epidural stimulation restores motor control in chronic motor complete patients. Peripheral nerve or functional electrical stimulation (FES) has long been used to activate sacral nerves to treat bladder and pelvic dysfunction and to augment motor function. In theory, FES should facilitate synaptic formation and motor recovery after regenerative therapies. Upcoming clinical trials provide unique opportunities to test the theory. INTRODUCTIONIn the past decade, several prominent laboratories have shown axonal regeneration in animal spinal cord injury (SCI) models, but locomotor recovery did not follow regeneration (277). For example Lu et al. (159,160) and He's group (156,282) regenerated many axons that synapsed with neurons in the lower spinal cord, but the animals did not recover walking. To explain the lack of locomotor recovery, the investigators assume that insufficient numbers of regenerated axons have formed synapses with appropriate neurons in the lower spinal cord to support locomotion. Another explanation for the lack of locomotor recovery after complete SCI and regeneration is that the animals did not learn to use their newly regrown connections.Regenerated fibe...

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Effects of Practice Combined with Somatosensory or Motor Stimulation on Hand Function in Persons with Spinal Cord Injury

Abstract: Hand training combined with either SS or FES was associated with improved hand use and corticomotor activity in persons with chronic tetraplegia. Both interventions appear to be equally effective.

Cited by 30 publications

References 27 publications

Use of Stereognosis combined with TENS to Promote Late Motor Recovery in an Individual with Incomplete Spinal Cord Injury: A Case Report

Use of Stereognosis combined with TENS to Promote Late Motor Recovery in an Individual with Incomplete Spinal Cord Injury: A Case Report

Priming for Improved Hand Strength in Persons with Chronic Tetraplegia: A Comparison of Priming-Augmented Functional Task Practice, Priming Alone, and Conventional Exercise Training

Electrical Stimulation and Motor Recovery

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